[The effect of characteristics of patient on satisfaction with medical care rendered by general practitioner and district therapist].

The patient satisfaction is one of the key criteria of quality of medical care and indicator of patient-oriented approach and factor determining competitiveness of medical organization. The purpose of the study - the comparative analysis of patient satisfaction with primary health care provided by general practitioner and district physician, taking into account their gender, age characteristics, frequency and goals of visiting polyclinic. Sociological study was carried out on the basis of out-patient medical organizations in Moscow, Kemerovo and Belgorod. The final analysis included 415 questionnaires of respondents aged 18 years and older. The patients with different rate and purposes of visiting medical institution are equally satisfied with medical care provided by general practitioner and district physician. The satisfaction with general practitioner may have gender characteristics. The satisfaction with district physician may have age characteristics. The satisfaction with both specialists may depend on health status of patient. The model of providing primary health care according to principle of general practitioner may be more universal, while according to principle of district physician more acceptable for elder patients. In order to increase satisfaction with primary health care for all categories of patients, it is necessary to consolidate best organizational approaches of both models.

[The rise of attractiveness of specialty "General Practice" for graduates of medical universities].

The choice of specialty by graduate of medical university can be promoted by particular social, demographic and personal characteristics. Purpose of the study is to investigate demographic, social and personal characteristics of students in residency on specialty "General Medical Practice" in the Russian Federation. The sociological, statistical and analytical methods are applied. The sampling for survey consisted of 81 respondents. The specialty "General Medical Practice" is chosen mainly by women residing in city, non-married and without children. They are not characterized by participation in public life and they are characterized by the presence of hobbies (hobbies). The choice is conditioned by multidisciplinary nature of medical care and scope of professional horizons. They are attracted by treatment work and are less interested in pedagogy and science. In perspective, 80% of female respondents are going to get another specialty. More than 70% of respondents plan to work in out-patient conditions and predominantly in state sector of health care. For women, main goals of further professional training are improvement in main and adjoining specialties and career promotion. And in educational program, internal diseases are of greatest interest. The preferred forms of training are internships and e-learning. The main direction of improving educational process is increasing of scope of practical training. The comparative analysis of study results with data of previous publications was implemented. The factors influencing commitment to specialty are revealed. The proposals increasing attractiveness of general medical practice for graduates of medical universities and keeping in specialty after residency are formulated.

[The influence of gender, age and length of service on educational preferences of general practitioners in Russia].

In conditions of active development of medical and pharmaceutical sciences and dynamically changing work environment the education of physician is to be both continuous and personalized. Purpose of the study. To investigate effect of gender, age and work experience on educational needs and on preferences of forms and methods of training in the system of continuing medical education of Russian general practitioners. The research bases were Chairs occupied with issues of personnel training for general medical practice in Moscow, Belgorod and Kemerovo. The sociological, statistical and analytical research methodologies were applied. The overall analysis covered 402 questionnaires for general practitioners. The sampling of respondents included 19.1% of men, 80.9% of women; 52.4% were aged 36-55 (60) years, 29.3% - 24-35 years and 18.3% - 56 (61) years and older; 45.0% had experience in general medical practice up to 2 years, 16.3% - 3-4 years, 27.0% - 5-6 years, 11.7% - 7 or more years. The results of comparative analysis of opinions of physicians of both genders and various age with different time of experience concerning level of significance for practice of various areas of competence within the framework of specialty and their preferences regarding organizational forms, training methods and its duration are presented. It is established that gender, age and length of service had no significant effect on the studied parameters. However, certain characteristics associated with these factors are identified. The further study of possible influence of other internal and external factors can contribute in the future into formulation of scientifically grounded approach to choosing personalized trajectory of education of general practitioner.

[The health status of workers in the production of compounds of nitrogen group (literature review)].

In the literature there are reported data about working conditions, health status of workers in the production of nitrogen group compounds (ammonia, nitric acid, urea, ammonium nitrate), as well as research of the impact of harmful factors of the production on the body in the experiment. Unsatisfactory working conditions are associated with an occupational hazard for health of workers and can lead to professional and work-related diseases. Despite a significant number of published studies, the mechanism of the toxic effect of the compounds of nitrogen group on the gastrointestinal tract of workers is not fully studied. There is a lack of data on the degree of the relationship of digestive disorders, including peptic ulcer and duodenal ulcer with the work on the such production. There is little scientific evidence about the clinical uniqueness of ulcer disease in workers exposed to compounds of nitrogen group, as well as information on the dietary prevention of the occurrence and development of the disease.

[Experience in improving the working conditions and health status of workers at a large chemical plant].

Working conditions were studied at a chemical plant manufacturing nitrogen compounds. The leading adverse industrial factor was found to be chemical as ambient air pollution from ammonia, nitric dioxide and oxide, and other substances. The plant's administration constantly keeps the working conditions and health status of workers under control. The sanitary laboratory monitoring noxious industrial factors has been operating at the plant for tens of years. Scheduled improvement of working conditions leads to their gradual improvement. Periodic medical examinations of workers exposed to adverse working conditions, timely treatment of patients (by showing in those with gastroduodenal ulcer diseases as an example), diets, medicines, etc. result in the workers' better health.

[Results of evaluating the functional state of the gastric mucosa in duodenal peptic ulcer by means of a test gastropanel in workers engaged in the manufacture of nitrogen compounds].

AIM: to study the specific features of working conditions in workers from the chemical plants manufacturing nitrogen compounds by the groups under study and by the time course of changes in the serum levels of gastrin-17 (G-17) and pepsinogen-1 (P-1) in relation to the chemical composition of noxious substances, the length of service, the stage of the disease, and the performed therapy. SUBJECTS AND METHOD: A test GastroPanel was used to study the serum levels of G-17 and P-1 in 54 patients with duodenal peptic ulcer (DPU) who worked at the chemical plants manufacturing nitrogen compounds (a study group) and in 15 healthy individuals (a control group). RESULTS: The objective data on the time course of changes in the functional characteristics (G-17 and P-1) of the gastric mucosa (GM) in patients with DPU vary with the chemical composition of noxious substances and the length of service in chemical industry. The basic therapy for PDU contributes to a positive change in the functional parameters reflecting the state of GM. CONCLUSION: In patients with DPU, the working conditions at the chemical plants manufacturing nitrogen compounds result in changes in the functional parameters reflecting the state of GM

[Occupational digestive diseases in chemical industry workers of West Siberia].

The high incidence of chronic digestive diseases is recorded in chemical industry workers exposed to the isolated action of noxious substances. The aim of the investigation was to make a hygienic assessment of the risk for occupational digestive diseases in chemical industry workers exposed to a combination of noxious drugs. The working conditions and the prevalence of digestive diseases were studied in 4120 workers engaged in chemical and auxiliary processes. Under the isolated action of noxious substances, the workers had an average of 35% increase in the incidence of digestive diseases than unexposed ones (p < 0.05). Under the combined action of hazardous substances, the incidence of digestive diseases was 1.7-fold greater (p < 0.05) than in the unexposed subjects and 1.2-fold greater in those under isolated action. The odd ratio and relative risk for digestive diseases in the workers exposed to a combination of noxious substances were 4.0-11.1 and 3.5-10.7 times higher, respectively (p < 0.05) than in the unexposed subjects.

[The serum content of gastrin-17 and pepsinogen-1 in patients with duodenal ulcerative disease in occupational contact with nitrogenous compounds].

The levels of serum gastrin-17 (G-17) and pepsinogen-1 (P-1) were studied in 54 patients with duodenal ulcerative disease (UD) who worked at chemical plants manufacturing nitrogenous compounds and in 15 healthy individuals (a control group). There are objective data on the time course of changes in the functional characteristics (G-17 and P-1) of the gastric mucosa (GM) in the patients with duodenal UD, which vary with the chemical compositions of hazardous substances and the length of service at a chemical plant. Basic therapy for UD causes positive changes in the functional parameters reflecting the state of GM.

[Prevalence of gastro-intestinal diseases in workers engaged into nitrogenous compounds production].

The authors demonstrated that a complex of occupational hazards on chemical enterprise of nitrogenous compounds production causes higher level of occupationally mediated diseases of gastrointestinal tract in the workers exposed.

[The comparative assessment of follow-up for hypertensive patients]. / Sravnitel'naia kharakteristika dispansernogo nabliudeniia za patsientami s arterial'noi gipertenziei.

The quality of outpatient follow-up was compared in hypertensive patients of the primary care system in 1995 vs 1997. Case records have been retrospectively analyzed for 1301 patients and 1335 ones treated in 6 Kemerovo outpatient clinics in 1995 and 1997, respectively. A special sheet was used for recording the data. More investigations of the target organs were made in 1997. An increase was found in the number of tests for total cholesterol, creatinine, blood glucose, blood count, urinalysis, ultrasound scanning of the kidneys and adrenals, ECG. More patients were taking drugs. Adelphan administration decreased by 32%, clophelin by 30%. More frequently were prescribed ACE inhibitors, calcium antagonists, beta-adrenoblockers. Quality of care for hypertensive patients is still low. This is explained by deficient social care, poor medical education of the patients, rejection of active treatment by many patients.

[Problems in secondary prevention of arterial hypertension in primary health care system]. / Problemy vtorichnoi profilaktiki arterial'noi gipertonii v pervichnom zvene zdravookhraneniia.

AIM: Assessment of the quality of follow-up of patients with arterial hypertension (AH) within the framework of primary health care system. MATERIALS AND METHODS: A retrospective analysis of outpatient case histories of 927 patients with AH treated at 6 health centers in the city of Kemerovo in 1995-1996 was carried out. A special table was created in order to assess the quality of follow up. This table included all data on the follow-up. RESULTS: The study revealed an insufficient volume of examinations of target organs over the latest two years: total analysis of the urine was carried out in only 572 patients, total cholesterol measured in 228, the fundus oculi examined in 384, and ECG performed in 615 patients; echoCG of the heart and major vessels was carried out in only 111 patients and loading tests in 24. Antihypertensive therapy was administered to 758 patients; only 216 of these took drugs regularly, 163 used none at all, and 543 patients took drugs only during exacerbations of disease. Very often they used ineffective drugs longer used now and caused numerous side effects: clofelin, adelphan, rauwolphine, dibasole, papaverine, magnesium sulfate. CONCLUSION: The quality of follow-up of patients with AH does not meet the modern requirements to follow-up due to various causes: 1) social neglect of patients; 2) physicians neglect modern recommendations on the diagnosis and treatment of AH; 3) physicians' efforts are not aimed at the prevention of disease complications, prolongation of the life span of patients, and improvement of the quality of their life; 4) patients are not ready to active treatment.